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Publication Name
World Journal of Psychiatry
ISSN
2220-3206
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study
Copyright ©The Author(s) 2025.
World J Psychiatry. Dec 19, 2025; 15(12): 109437
Published online Dec 19, 2025. doi: 10.5498/wjp.v15.i12.109437
Table 1 Baseline characteristics of heart failure patients with depression, mean ± SD, % (n/total)
Variables
Total (n = 160)
No/mild depression (n = 100)
Moderate/severe depression (n = 60)
Test statistic
P value
Age, years75 ± 973 ± 578 ± 9t = 2.040.045
Male63.1 (101/160)40.0 (40/100)23.3 (14/60)χ2 = 5.30.021
BMI, kg/m225 ± 325 ± 324 ± 3t = 0.990.322
Heart rate, bpm82 ± 1480 ± 1386 ± 15t = 2.060.041
Systolic bp, mmHg118 ± 16120 ± 15115 ± 17t = 1.840.067
Diastolic bp, mmHg71 ± 1072 ± 969 ± 11t = 1.560.119
NYHA class II23.8 (38/160)31.0 (31/100)11.7 (7/60)χ2 = 4.60.032
NYHA class III19.4 (31/160)22.0 (22/100)15.0 (9/60)χ2 = 1.50.217
NYHA class IV9.4 (15/160)8.0 (8/100)11.7 (7/60)χ2 = 4.30.039
Coronary artery disease51.9 (83/160)38.0 (38/100)13.3 (8/60)χ2 = 5.00.026
Prior myocardial infarction38.1 (61/160)27.0 (27/100)11.7 (7/60)χ2 = 3.90.048
Diabetes mellitus40.0 (64/160)25.0 (25/100)15.0 (9/60)χ2 = 3.20.072
Hypertension61.3 (98/160)44.0 (44/100)16.7 (10/60)χ2 = 4.40.035
Hyperlipidemia36.3 (58/160)26.0 (26/100)10.0 (6/60)χ2 = 4.10.043
Low education level45.0 (72/160)28.0 (28/100)16.7 (10/60)χ2 = 3.80.038
Divorced/separated21.9 (35/160)10.0 (10/100)11.7 (7/60)χ2 = 4.20.042
Etiology of CHF: Ischemic60.0 (96/160)45.0 (45/100)15.0 (9/60)χ2 = 5.70.018
BMI: Body mass index; NYHA: New York Heart Association; CHF: Congestive heart failure.
Full Size Table
Table 2 Medication use and adherence stratified by depression severity, % (n/total)
Variables
No/mild depression (n = 100)
Moderate/severe depression (n = 60)
Test statistic
P value
β-blocker use68.0 (68/100)53.3 (32/60)χ2 = 3.50.061
ACE inhibitor/ARB use70.0 (70/100)56.7 (34/60)χ2 = 3.70.054
Diuretic use75.0 (75/100)61.7 (37/60)χ2 = 3.00.084
Antidepressant use9.0 (9/100)16.7 (10/60)χ2 = 2.60.107
Anxiolytic use7.0 (7/100)13.3 (8/60)χ2 = 2.90.091
Psychotherapy6.0 (6/100)18.3 (11/60)χ2 = 4.10.043
High adherence (MMAS-4 = 0)40.0 (40/100)25.0 (15/60)χ2 = 4.60.031
Moderate adherence (MMAS-4 = 1-2)38.0 (38/100)40.0 (24/60)χ2 = 0.10.794
Low adherence (MMAS-4 = 3-4)22.0 (22/100)35.0 (21/60)χ2 = 3.90.048
ACE: Angiotensin-converting enzyme; ARB: Angiotensin II receptor blocker; MMAS-4: Morisky Medication Adherence Scale.
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Table 3 Clinical indicators and treatment of heart failure patients with depression, mean ± SD/% (n/total)
VariablesTotal (n = 160)No/mild depression (n = 100)Moderate/severe depression (n = 60)Test statisticP value
LVEF30 ± 834 ± 726 ± 6t = 2.20.031
LVEF ≤ 20%18.1 (29/160)10.0 (10/100)31.7 (19/60)χ2 = 4.10.042
PHQ-9 score7 ± 34 ± 212 ± 4t = 6.2< 0.001
NT-proBNP, pg/mL, median (interquartile range)3000 (1800-4700)2700 (1600-4100)3900 (2100-5400)Z = 2.10.038
CRP, mg/L8.5 ± 3.27.9 ± 3.19.6 ± 3.3t = 1.70.084
Hemoglobing, dL11.2 ± 1.511.4 ± 1.310.7 ± 1.6t = 1.80.076
Serum albumin, g/L38 ± 439 ± 336 ± 4t = 1.90.058
Serum creatinine, μmol/L109 ± 36102 ± 34121 ± 38t = 1.90.062
Length of hospital stay, days, median (interquartile range)9 (6-13)8 (5-11)11 (7-15)Z = 1.80.071
Use of psychotherapy10.0 (16/160)4.0 (4/100)20.0 (12/60)χ2 = 6.40.011
Worsening CHF45.0 (72/160)28.0 (28/100)73.3 (44/60)χ2 = 4.80.029
Myocardial infarction20.0 (32/160)14.0 (14/100)30.0 (18/60)χ2 = 2.90.086
Unstable angina15.0 (24/160)9.0 (9/100)25.0 (15/60)χ2 = 1.10.294
Arrhythmia11.9 (19/160)7.0 (7/100)20.0 (12/60)χ2 = 0.80.371
Other admission8.1 (13/160)5.0 (5/100)13.3 (8/60)χ2 = 0.50.478
β-blockers at discharge65.0 (104/160)43.0 (43/100)21.7 (13/60)χ2 = 5.00.027
Calcium blockers30.0 (48/160)20.0 (20/100)10.0 (6/60)χ2 = 3.40.068
ACE inhibitors70.0 (112/160)48.0 (48/100)21.7 (13/60)χ2 = 5.20.023
Diuretics75.0 (120/160)50.0 (50/100)25.0 (15/60)χ2 = 5.60.019
Nitrates50.0 (80/160)35.0 (35/100)15.0 (9/60)χ2 = 4.20.041
Antidepressants20.0 (32/160)8.0 (8/100)11.7 (7/60)χ2 = 4.40.036
Anxiolytics18.1 (29/160)5.0 (5/100)13.3 (8/60)χ2 = 3.90.046
LVEF: Left ventricular ejection fraction; PHQ-9: Patient Health Questionnaire-9; CRP: C-reactive protein; CHF: Congestive heart failure; ACE: Angiotensin-converting enzyme.
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Table 4 Cardiovascular event readmissions in 1-year follow-up with median time to event, median (interquartile range)
Cardiovascular event type
Number of patients (n = 48)
Proportion of readmitted patients (%)
Median time to event (days)
Worsening HF2654.290 (60-150)
Acute coronary syndrome (MI + UA)918.8120 (90-180)
Arrhythmia-related hospitalization714.6150 (120-210)
Sudden cardiac death/mace48.3210 (180-300)
Other cardiovascular causes24.2180 (150-270)
HF: Heart failure; MI: Myocardial infarction; UA: Unstable angina.
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Table 5 Univariable analysis of risk factors for 1-year cardiovascular event readmission, mean ± SD/%
Variable
Event group (n = 48)
No event group (n = 112)
P value
Age, years77 ± 874 ± 90.042
Male50660.067
Heart rate, bpm84 ± 1481 ± 140.219
NYHA class IV17140.049
Coronary artery disease61520.284
Prior MI46350.191
Hypertension58630.548
Hyperlipidemia31370.441
Low education level42320.228
Divorced/separated19180.889
Ischemic etiology52650.113
LVEF27 ± 732 ± 80.006
LVEF ≤ 20%27120.023
PHQ-9 score9 ± 46 ± 3< 0.001
NT-proBNP, median (interquartile range), pg/mL3950 (2300-5600)2900 (1600-4300)0.041
Use of psychotherapy1780.086
β-blocker use at discharge48720.027
ACE inhibitor use60740.091
Diuretic use65780.084
Nitrate use46520.486
Antidepressant use10120.723
Anxiolytic use1590.237
Worsening CHF as admission63410.041
NYHA: New York Heart Association; MI: Myocardial infarction; LVEF: Left ventricular ejection fraction; PHQ-9: Patient Health Questionnaire-9; NT-proBNP: N-terminal pro-B-type natriuretic peptide; ACE: Angiotensin-converting enzyme; CHF: Congestive heart failure.
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Table 6 Multivariable Cox regression analysis of independent predictors for 1-year cardiovascular event readmission
Variable
Hazard ratio
95% confidence interval
P value
Age1.0281.005-1.0520.016
LVEF0.9690.947-0.9910.009
PHQ-9 score1.0591.025-1.094< 0.001
β-blocker use0.7320.562-0.9530.024
NT-proBNP1.0181.003-1.0330.021
Psychotherapy1.4470.912-2.2960.112
NYHA class IV1.6111.102-2.3540.037
Worsening CHF at admission1.7231.103-2.6940.031
LVEF: Left ventricular ejection fraction; PHQ-9: Patient Health Questionnaire-9; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NYHA: New York Heart Association; CHF: Congestive heart failure.
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